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Background <p>Dyslipidemia is highly prevalent among patients with cancer and contributes to elevated cardiovascular risk and adverse clinical outcomes. Although omega-3 polyunsaturated fatty acids (PUFAs) improve lipid profiles in the general population, their lipid-modifying effects in oncology settings remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) with particular emphasis on subgroup analyses to identify potential effect modifiers.</p> Methods <p>PubMed, Scopus, Web of Science, and Embase were systematically searched through Jun 24, 2026. RCTs evaluating the effects of omega-3 supplementation on triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in cancer patients were included. Pooled weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Prespecified subgroup analyses were conducted according to baseline lipid status, body mass index (BMI), age, sex, omega-3 dose, and intervention duration. Risk of bias and certainty of evidence were assessed using RoB 2 and GRADE.</p> Results <p>Fourteen study arms from 13 RCTs were included. Omega-3 supplementation significantly reduced TG levels (WMD:  − 17.91&#xa0;mg/dL; 95% CI  − 30.06 to − 5.76; low-certainty evidence) and increased HDL-C (WMD: + 2.98&#xa0;mg/dL; 95% CI 0.93–5.02; low-certainty evidence), with no significant overall effects on TC (WMD:  − 3.50&#xa0;mg/dL; 95% CI  − 4.13 to 11.14; very low-certainty evidence) or LDL-C (WMD: + 3.21&#xa0;mg/dL; 95% CI  − 1.67 to 8.09; low-certainty evidence). Subgroup analyses revealed clinically meaningful heterogeneity. TG reductions were greater in patients with baseline hypertriglyceridemia, BMI ≥ 25&#xa0;kg/m<sup>2</sup>, age &lt; 60&#xa0;years, and in trials using ≥ 2,000 mg/day. HDL-C increases were more pronounced in women, younger participants, those with BMI &lt; 25&#xa0;kg/m<sup>2</sup>, higher baseline HDL-C levels, higher omega-3 doses, and intervention durations &gt; 12&#xa0;weeks. In contrast, LDL-C remained unchanged across all subgroups. TC responses varied by dose and sex, with increases observed at lower doses (&lt; 2000&#xa0;mg/day) and among women. Sensitivity analyses confirmed robustness of findings.</p> Conclusions <p>Omega-3 supplementation improves TG and HDL-C levels in cancer patients, with effects strongly modified by baseline metabolic status, BMI, age, sex, dose, and treatment duration. These findings highlight the importance of patient stratification and suggest that omega-3 therapy may be particularly beneficial for metabolically high-risk oncology subgroups. Personalized nutritional strategies may enhance cardiometabolic management in cancer care.</p>

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Effects of omega-3 fatty acid supplementation on lipid profiles in cancer patients: a systematic review and meta-analysis of randomized controlled trials through a GRADE analysis of evidence

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月17日

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  • YangXin Wang,
  • Xinxin Ye,
  • Weiwei Lin,
  • Kousalya Prabahar,
  • Mohammad Safargar,
  • Hamed Kord-Varkaneh

摘要

Background

Dyslipidemia is highly prevalent among patients with cancer and contributes to elevated cardiovascular risk and adverse clinical outcomes. Although omega-3 polyunsaturated fatty acids (PUFAs) improve lipid profiles in the general population, their lipid-modifying effects in oncology settings remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) with particular emphasis on subgroup analyses to identify potential effect modifiers.

Methods

PubMed, Scopus, Web of Science, and Embase were systematically searched through Jun 24, 2026. RCTs evaluating the effects of omega-3 supplementation on triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in cancer patients were included. Pooled weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Prespecified subgroup analyses were conducted according to baseline lipid status, body mass index (BMI), age, sex, omega-3 dose, and intervention duration. Risk of bias and certainty of evidence were assessed using RoB 2 and GRADE.

Results

Fourteen study arms from 13 RCTs were included. Omega-3 supplementation significantly reduced TG levels (WMD:  − 17.91 mg/dL; 95% CI  − 30.06 to − 5.76; low-certainty evidence) and increased HDL-C (WMD: + 2.98 mg/dL; 95% CI 0.93–5.02; low-certainty evidence), with no significant overall effects on TC (WMD:  − 3.50 mg/dL; 95% CI  − 4.13 to 11.14; very low-certainty evidence) or LDL-C (WMD: + 3.21 mg/dL; 95% CI  − 1.67 to 8.09; low-certainty evidence). Subgroup analyses revealed clinically meaningful heterogeneity. TG reductions were greater in patients with baseline hypertriglyceridemia, BMI ≥ 25 kg/m2, age < 60 years, and in trials using ≥ 2,000 mg/day. HDL-C increases were more pronounced in women, younger participants, those with BMI < 25 kg/m2, higher baseline HDL-C levels, higher omega-3 doses, and intervention durations > 12 weeks. In contrast, LDL-C remained unchanged across all subgroups. TC responses varied by dose and sex, with increases observed at lower doses (< 2000 mg/day) and among women. Sensitivity analyses confirmed robustness of findings.

Conclusions

Omega-3 supplementation improves TG and HDL-C levels in cancer patients, with effects strongly modified by baseline metabolic status, BMI, age, sex, dose, and treatment duration. These findings highlight the importance of patient stratification and suggest that omega-3 therapy may be particularly beneficial for metabolically high-risk oncology subgroups. Personalized nutritional strategies may enhance cardiometabolic management in cancer care.